Steve DaviesConsultant Endocrinologist

Director OnExamination.com

H@N e-learning resource

Background

• Limited hours - EWTD– Clinical service– Shift systems – 24 hr hospital/H@N

• Education/training– ↑ Demand but with flexibility– ↑ Supervision and evidence of learning– Examinations/CPD/revalidation– Change in workforce

Innovative + flexible education

E-learning

Working

HoursEducation

Training

Achieving A Balance

e-learning trends

• 86% use of the internet as primary source of medicalinformation. Younger, female1

• Webpages are the preferred medium (90% vs 49% vs 4th

survey) for seeking healthcare information

• PubMed, Medscape, WebMD• Activity Nurses > Doctors; females > males

• 53% access mostly from home

• J Med Educ 2004 2. 5th HON survey

OnExamination.com

Quizzes

Santa, has been a little worried abouthis health of late. To which of thefollowing conditions does hisoccupation predispose?

• Alzheimer’s dementia

• Christmas disease

• Cryoglobulinaemia

• Elf disease

• Lyme disease

• Menkes kinky hair disease

• Melanoma

• Rickets

• Scrotal carcinoma

• Seasonal affective disorder

Answer: I

As the Christmas carol goes ‘My beard is black there’s soot in my sacks’, hence he must have considerable exposure to soot which is a carcinogen.Percival Potts described scrotal cancer amongst Chimney sweeps in 1878. He is not predisposed to any other conditions listed as he barely sees thesun being a resident of the North Pole, hence Melanoma is out and also he is protected against Rickets because of his high Milk intake. Lyme diseaseis less likely in deer in the artic region as it is found in temperate climates. Christmas disease is a haemophilia and Santa is not a bleeder. Seasonalaffective disorder is really not a likely choice as he is a profoundly Jolly Soul.

H@N e-learning project

• The ‘24hr hospital’ - shift system• 9-5 teaching

• Complementary e-learning resource• Learning material/protocols with assessment• Nurse practitioners and Junior doctors

What works at an educationallevel?

• Is it reading material alone?• Is it reading material plus assessment?• Evidence lacking

Study Design

• LimitedOnly reading material

• FullReading material withAssessment questions

Initial test

6 weeks of learning

Final test

Comparison of scores and use of the site

Objective measures of site by questionnaire

H@N sitehttp://han.medelect.co.uk/default.asp

• Nurse Practitioner resource (4-6 weeks)Initial and final test of 22 questions.Reading: Clinical skills/ECGs/Fire trainingAssessment: MCQ assessment questions:

31 clinical skills/22 ECGs and 12 Fire SafetyReflection areaSupervisor function

• Junior Doctor resource (ready mid June)Initial test of 25 questionsReading: Algorithms and guidelines in medicine and surgeryAssessment: 60+ medicine/60+surgery/22 ECGs and 12 Fire SafetyReflection areaSupervisor function

Interim resultsNP Resource

p<0.01

p = 0.1

p<0.005

P value

n = 1355%

n = 1277%

Final Test

53.9%61.9%Initial Score

52 mins119 minsTime spent

35 (77)45.4%

47 (87)54.1%

Users (total)%

LimitedFull

Analysis of ‘Full Account Users’

p<0.005 n = 1781.9%

n = 2664.6%

Clinical (31)

p<0.01n = 1183.4%

n = 2152%

ECG (22)

P valueFinal ScoreNaïve Score

NA NAn = 1783.4%

Fire (12)

Questionnaire

What was the most useful feature

0

2

4

6

8

10

12

Full Limited

Full 4 4 11

Limited 3 7 2

reading pictures questions reflection

My knowledge has been improved through using this package

0

1

2

3

4

5

6

Full Limited

Full 3 3 5 1 0

Limited 0 3 4 1 1

Strongly Agree Agree Neutral Disagree Strongly disagree

I found the online material easier to use than conventional books and other learning aids

0

1

2

3

4

5

6

Full Limited

Full 5 4 2 1 1

Limited 0 4 2 3 0

Strongly Agree Agree Neutral Disagree Strongly disagree

I will be able to apply the new knowledge in the workplace

0

1

2

3

4

5

6

7

Full Limited

Full 3 6 3 1 0

Limited 0 4 3 2 0

Strongly Agree Agree Neutral Disagree Strongly disagree

‘Points of View’• LimitedThe idea is good but the site does not match up to the promise.

The crash course books give more info than this project.

Makes you think about specific conditions. Impossible to see the ECGs properly

Flexible and fun to do with colleagues!!! More questions

Music would add value as I find looking at these things at night soporific

• FullEasy to use and accessible at work.

In future no cut off point. Very easy to use and dip in and out of.

Easily accessable.

Difficult to find time to access the resource

I have found the site valuable

Generally very good. ECGs were too small

Supervisor comments

• NP’s need a standard …. at advanced practice. H@Noffers this …. and is a robust assessment tool.

• H@N (site) ….. provides evidence for NMC• Could be used in the process of selection at interview.• Valuable independent measure of group’s learning

activities, strengths and weaknesses.• May provide cost savings for study leave and reduced time

away from service. Assists appraisal.

Summary

• The addition of assessment questionsObjectively– x2↑ time spent interacting with site– Improved scores at the end of the study period– Completion mandatory/statutory trainingSubjectively– Greater satisfaction

Conclusions• E-learning continues to gather momentum• Assessment/validation is an integral

component of the education and assistslearning.

• Opportunities– Develop modular programmes – Elsevier– Indemnification savings – incidents/ECGs.– Assessment in short-listing and/or interview– PDPs/CPD/CME/Appraisal

Acknowledgements

• OnExamination.comCourtenay Probert, Gareth Ashby, Darren Summers, Helen Davies

• UHWDelyth Martin, Phil Smith and Phil Matthews

Bernie Foley, Kevin Conway, Richard Chudleigh, Aled Roberts

• AssemblyAdam Brown, Esyld Watson, Jane Ashwell